Student Voice

Mental Health Care Too Often Put on Hold

(December 2017) Imagine the frustration of trying to reach a counsellor and instead
hearing “we’re sorry, the number you have dialed is no longer in
service.”

Then imagine hearing it again for the second provider you try.

In
our personal lives and in our work with preceptors, my fellow medical
students, MariaElena Williams and Tae Chang, and I had witnessed people
struggling with access behavioral health services.

Our mentor,
Deb Seymour, PsyD, a primary care psychologist and associate professor
of family medicine, who faces these challenges day in and day out, is
aware of the significance of this problem, and wanted a way to quantify
it.

Together, with these observations so vivid in our lives, we
developed our Mentored Scholarly Activity (MSA) project, a requirement
of our CU School of Medicine education.

The manuscript that
resulted from our study was published last summer in Annals of Family
Medicine. In short, we found that even for people who are well insured,
finding a mental health provider is difficult and time-consuming.

Wrong number

The
summer after our first year of medical school, we three medical
students collectively placed nearly 2,000 calls to psychiatrists,
psychologists, licensed clinical social workers, and licensed
professional counselors in the Denver area.

During these calls,
each of us posed as a patient with symptoms of moderate depression who
was seeking an appointment covered by our commercial insurance carrier.

Those calls offered a glimpse into the uphill battle a patient faces when referred to therapy.

To
start, the list of preferred providers for a specific insurance plan
often provided incorrect or out-of-date information. Many phone numbers
listed – we found 13 percent of them – were incorrect.

As of 2016,
one year after we completed our data collection, federal guidelines
require monthly directory updates. We hope that better oversight will
decrease the unacceptably high number of inaccurate entries.

Other barriers

Beyond
inaccurate phone numbers, we encountered providers who were no longer
on the insurance company’s panel of approved providers, who worked only
with select patient populations (e.g. those with eating disorders), and who simply had schedules too full to take new appointments.

The
net result? Fewer than half of our calls resulted in an appointment.
Psychiatry openings were particularly difficult to schedule. Based on
our data, a patient needs to call seven to 10 psychiatrists to find an
open appointment.

Most people with depression strain to complete
the usual activities of daily life. Initiating new behavior is grueling
for them. Is it really reasonable to expect those struggling with
depression to complete the laborious process of accessing an online
directory, calling multiple providers, waiting for return calls, and
traveling – potentially great distances – to an appointment?

Insurance Does Not Guarantee Access

While
Colorado’s uninsured rate fell from 14.3 percent in 2013 to 6.7 percent
in 2015, our data indicates having health insurance does not guarantee
access to behavioral health care. Surprised? We weren’t.

The
Affordable Care Act includes mental health services as an essential
health benefit for which insurance companies must provide “a network
that is sufficient in numbers and types of providers…to assure that all
services will be accessible without unreasonable delay.” But what is
sufficient? It’s not defined. Several states have enacted additional
legislation to clarify this requirement, but Colorado is not among them.

Our
research focused on behavioral health care in metro Denver, but
limitations in access are pervasive across regions and specialties.
While conducting our research, we noted similar findings have
demonstrated for psychiatric care in Maryland and New Jersey and for
primary care in California.

While the future of health care
reform still remains unclear, we feel strongly that network inadequacy
must be addressed to ensure our patients can obtain the services they
need.

Jamie Gilroy and Tae Chang are members of the medical
school class of 2018. MariaElena Williams, MD, graduated in May. This
project was their Mentored Scholarly Activity, a four-year requirement
for all medical students.